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All about Medical Insurance Eligibility

Providing the best medical insurance for your family may not always be possible, though the toughness of the task will depend on the state in which you reside. Because most states in the US allow for insurance regulators to pick and choose who they do and do not want to cover, this means that you or a family member may be denied for a number of reasons. The reasons these regulations are in place is because otherwise families would simply seek coverage when they needed it most such as when they need expensive medical coverage. If that scenario existed then insurance premiums would be astronomical for everyone and this would not be fair to those who are always insured.


Many people are caught off guard as to how strict insurance providers can be with their guidelines but what is important to remember is that just because you view a medical condition that you or a family member has as minor, it may not be viewed the same way by the insurance provider. Insurance providers may be more concerned with what else can come as a result of the minor condition that someone has. For example, if a person is classified as obese but has no history of medical conditions, they can still be denied coverage as obesity often leads to hear attacks and diabetes. In the eyes of the insurance provider, that person just isn’t worth the risk.


Another important point to know is that not all family members will always be accepted on the same plan and it is not uncommon for insurance providers to deny coverage for one or more family members while offering to cover the rest of the family members. This is due to the fact that the insurance providers look at each member of a family on an individual basis and make their decision from there. If you find this is your dilemma you then need to decide whether you will split the family members into more than one plan or will you continue to shop around until you find a provider that will insure the entire family. You can compare rates by obtaining rate comparisons for the family split options regarding the denial of certain family members. If your family is uninsured it is always best to insure whoever you can as you never know what will happen in life. You can always cancel your plan after finding a new plan and ensuring it is active.


You should also be aware of a term called ‘rate up.’ If an insurance company views a member of your family as a risk, but not a big enough risk to deny coverage they may ‘rate up’ the premiums that the entire family will pay. If this happens it is essential to find out if you would be better off splitting that family member onto their own medical insurance plan so that the family’s premiums don’t all go up.


You may find that certain family members are simply uninsurable due to a major illness and in this case you still have options. Many states sponsor programs for ‘high-risk’ people and if your uninsurable family member is a child then you can look into a program called State Children’s Health Insurance Programs, or SCHIP for short. While these options are a last resort they are none the less still options.


Finding out who is and isn’t eligible for medical insurance in your family can be a somewhat time consuming task. But because you never know what tomorrow will bring it is a task that you must take the time to complete. provides free medical insurance rate comparisons. Family medical insurance, individual medical insurance, group medical insurance.

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